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Credit Application form

2pho

Business Identity

Please provide the legal details for the entity applying for credit.

Billing Address

Company Name*

Attention*

Street Address

Residential:*

Yes

Address*

Street Address City State ZIP Code

Telephone Number*

Email*

Same as my office/shipping address

Office/Shipping Address

Company Name*

Attention*

Street Address

Residential:*

Yes

Address*

Street Address City State ZIP Code

Telephone Number*

Email*

General Information

Please provide the legal identity and contact details for the business applying for credit.

Corporation State of*

Company Composition*

Individual

Partnership

Corporation

LLC

Federal Tax ID No.*

Dun & Bradstreet (D&B) No.*

At present location since date*

MM slash DD slash YYYY

Are premises leased?*

Yes

Amount of credit desired*

Principal Contact*

Title*

Email*

Phone #*

Extension

bank information

Please provide details for your primary banking institution to allow for financial reference verification.

Bank Name*

Branch Name*

Bank Contact Officer*

Phone #*

Extension

Address*

Bank Address City State ZIP Code

Account Type*

Account #*

Please Specify*

Terms and Conditions

All invoices are to be paid within 30 days from the date of the invoice. By submitting this application, you authorize Daytona Redi Mix to make inquiries into the banking and business/trade references that you have supplied. I agree to the terms as stated above.

Customer Signature*

Max. file size: 50 MB.

Date*

MM slash DD slash YYYY

Acceptance and Approval

Please acknowledge the terms of credit and authorize Daytona Redi Mix to proceed with necessary background checks.

Credit Approval Signatures

Name*

First Name Last Name

Date*

MM slash DD slash YYYY

Credit Limit Approved*

Credit References

Please provide supplying references with addresses & phone numbers.

Credit References

Name	Actions

There are no References.

Maximum number of references reached.

Personal Information

Please provide the personal details of the owner for the purpose of the personal guaranty required to establish the credit account.

I refuse to fill out this Personal Guaranty

Personal Guaranty

If the buyer is a corporation or Limited Liability Company other than those signing this agreement, a personal guaranty by a responsible individual is required. The individual who signs this agreement as personal guarantor, acknowledges that they are a responsible as required, and hereby personally guarantees payment for all obligations of Buyer to Seller arising under this agreement such guaranty is absolute and unconditional. Seller would not enter this contract for Materials on open account, extend credit to buyer, or provide materials on account, without the Personal Guaranty, which is an express inducement to Seller to supply the materials to be supplied here under.

Name*

First Name Last Name

Address*

Street Address City State ZIP Code

Principal’s SS#*

Home Phone*

Guarantor Signature*

Max. file size: 50 MB.

Printed Name of Guarantor*

Consent*

I agree to the Terms of Service*

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CONTACT INFO

(586) 254-2212

sales@daytonaredimix.com

7520 23 Mile Road, Shelby Township, MI 48316

STANDARD HOURS

Monday – Friday: 6:00 AM to 5:00 PM

Saturday: 6:00 AM to 12:00 PM

Note: Available for off-hours and night work by arrangement.

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Terms & Conditions

Credit Application form

Business Identity

Billing Address

Office/Shipping Address

General Information

bank information

Terms and Conditions

Acceptance and Approval

Credit Approval Signatures

Credit References

Personal Information

Personal Guaranty

READY TO BUILD?CONTACT OUR TEAM.

SAFETY, QUALITY & SERVICE

READY TO BUILD?
CONTACT OUR TEAM.